=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962749804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY D TAYLOR PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2013
-----------------------------------------------------
Last Update Date | 01/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25771 PERDIDO BEACH BLVD
-----------------------------------------------------
City | ORANGE BEACH
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36561-6107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-980-1445
-----------------------------------------------------
Fax | 251-980-1468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25771 PERDIDO BEACH BLVD
-----------------------------------------------------
City | ORANGE BEACH
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36561-6107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-980-1445
-----------------------------------------------------
Fax | 251-980-1468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16805
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------